危重病性肌病中连续电刺激对神经肌肉功能障碍的暂时逆转。

Temporary reversal of nerve and muscle dysfunction by serial electrical stimulation in critical illness neuromyopathy.

机构信息

Department of Neurology, University of Leipzig, Germany, Liebigstr. 20, 04103 Leipzig, Germany; Department of Neurology of S. Khechinashvili University Clinic, Tbilisi State Medical University, Chavchavadze Ave. #33, 0179 Tbilisi, Georgia.

Department of Intensive Care Medicine and Neurology, Klinik Bavaria, Comprehensive Sepsis Center, Dresden-Kreischa, Germany, An der Wolfsschlucht 1-2, 01731 Kreischa, Germany.

出版信息

Clin Neurophysiol. 2022 Oct;142:244-253. doi: 10.1016/j.clinph.2022.07.509. Epub 2022 Aug 18.

DOI:10.1016/j.clinph.2022.07.509

PMID:36084575

Abstract

OBJECTIVE

Critical Illness Neuromyopathy (CIPNM) is a complication in sepsis patients with still enigmatic disease mechanisms. We investigated a novel electrical stimulation method to better define neuromuscular dysfunction in patients with CIPNM.

METHODS

We studied 18 sepsis CIPNM patients on intensive care units, 13 at an early and 5 at a later disease stage, 7 sepsis control, and 8 neuropathy control patients. We applied slow conditioning electrical pulses at motor nerves and directly at the muscle to investigate a facilitation phenomenon (FP) of small or absent compound motor action potentials (CMAPs).

RESULTS

Serial pulses induced a 2 to 490-fold increase in CMAP amplitudes in 17/18 Intensive Care Unit (ICU)-CIPNM patients (p < 0.001). These effects were short lived and reproducible. Direct muscle stimulation in the tibialis anterior muscle resulted in up to 130-fold FP in 7/9 patients tested (p < 0.01). In 4/5 post-ICU CIPNM patients FP was up to 10-fold. None of the 7 ICU sepsis control patients without CIPNM with similar disease severity and none of 8 neuropathy patients showed FP (p < 0.001). On needle EMG only 5/16 ICU patients tested revealed spontaneous activity.

CONCLUSIONS

Conditioning electrical stimulation detected a functional component of the disease process showing temporary improvement in sepsis-associated CIPNM.

SIGNIFICANCE

New test differentiates functional from degenerative pathology.

摘要

目的

危重病性肌病（CIPNM）是脓毒症患者的一种并发症，其发病机制仍不清楚。我们研究了一种新的电刺激方法，以更好地定义 CIPNM 患者的神经肌肉功能障碍。

方法

我们研究了 18 名在重症监护病房的脓毒症 CIPNM 患者，13 名处于早期，5 名处于晚期，7 名脓毒症对照组，8 名神经病变对照组。我们在运动神经和肌肉上施加缓慢的条件性电脉冲，以研究小或不存在复合运动动作电位（CMAP）的易化现象（FP）。

结果

在 17/18 名重症监护病房（ICU）-CIPNM 患者中（p<0.001），连续脉冲可使 CMAP 幅度增加 2 至 490 倍。这些效果是短暂的且可重复的。在前胫骨肌直接肌肉刺激可使 7/9 名测试患者的 FP 高达 130 倍（p<0.01）。在 4/5 名 ICU 后 CIPNM 患者中，FP 高达 10 倍。在没有 CIPNM 的 7 名 ICU 脓毒症对照组患者中，没有任何一名患者出现 FP，这些患者的疾病严重程度相似，也没有 8 名神经病变患者出现 FP（p<0.001）。在针极肌电图中，只有 16 名 ICU 患者中的 5 名患者显示出自发性活动。